[Life environment, healing and treatment with neuroleptics in schizophrenia].
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Biomedical subjects
Publications and source records attributed to J Cullberg.
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By means of a computerised psychiatric case register, the effects on a defined population with 71,371 inhabitants were studied when the mainly hospital-based psychiatric services in the area were changed to community mental health units with substantial outpatient resources. Diagnostic, social and demographic variables and care utilisation rates were compared. A 29% increase in patients under the new system was observed. Most of the newcomers had acute crisis reactions, were younger, on average, than previous patients and registered alcohol abuse and somatic diseases. Outpatient utilisation increased (170%) and hospital admissions decreased (22%). Compulsory admissions increased (43%), as did sick-leave registrations (21%). These trends are discussed in light of the new organization.
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By means of a psychiatric case register the total psychiatric population in the Nacka region (75,000 inhabitants) was analysed during a 2-year period with regard to the amount of psychotherapy consumed in different social groups. Among the patients, the utilization of psychotherapy was 60% for social group I compared with 30% for social group III. However, the lowest social groups are overrepresented at the mental health unit. Thus, among the total population, the utilization of psychotherapy was 1.8% for social group I compared with 5.3% for social group III. The study discusses the "clinical fallacy", by which data from a patient population is applied to the whole population, giving wrong or restricted perspectives to the problem studied. It is claimed that the selectivity of the psychiatric organization concerning social groups is an important factor for the so-called "social class bias" in psychotherapy.
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